Specialist suspended after going back to paper-based orders at Nanaimo hospital

A specialist has lost privileges at Nanaimo Regional General Hospital after a return to a paper-based ordering system, according to Dr. David Forrest, president of Nanaimo Medical Staff Association.

Forrest said a group of people in internal medicine, including himself, returned to using paper orders Thursday morning feeling they can no longer ethically support IHealth’s computer order management process and it’s prompted suspension of a member. He said the group suspects there will be more discipline to follow.

“It’s just awful that the health authority who have consistently ignored the concerns that have been raised by medical and allied health professional staff now for over a year, that we have to put our careers on the line in the interest of patient safety,” said Forrest, who said as a member of the internal medicine group and one of those who writes orders, he will stick to his ethical principles.

“Patient safety is paramount and even if that means disciplinary action, my responsibility as a physician is to do the right thing for patients.”

The decision to write paper orders comes after Island Health announced a reversal in an earlier decision to suspend a key part of the IHealth system which allows doctors to place electronic orders for tests and medication. The health authority had agreed in February to put the order entry system on hold, following a vote of 75 per cent of the Nanaimo Medical Staff Association who felt it should be suspended until redesigned.

But according to a statement this April from Island Health, that order system is “fundamentally interwoven” with other key parts of IHealth and suspending it would significantly impact those functions and jeopardize benefits realized by patients, like enhanced medication safety.

Forrest said the medical staff association was disturbed by the reversal of the decision. There’s broad concern among staff that there are problems with the system that have not been addressed and that it needs to be redesigned and suspension is required to do that, he said. He added that Island Health doesn’t seem to understand that the computer order management process is laborious, prone to error and inefficient, and that raises safety concerns in the entry of orders and a reduction in efficiency, which reduces access.

Among issues, he said, are problems with the order process that lead to medications being dropped off the medication record and orders being altered in the system, which can lead to error.

Forrest said Island Health was given six weeks’ notice that because no action was being taken to suspend the system, steps would be taken to do so, “so we’ve given them plenty of notice to put procedures in place in order to deal with this.” Further notice was given March 24 and April 21, correspondence shows.

“It’s not a protest, it’s an unwillingness to continue to use a system we feel poses a risk of harm to our patients,” Forrest said.

Dr. Alan Ruddiman, Doctors of B.C. president, said in a e-mailed statement: “We are extremely concerned that Island Health would impose this disciplinary action on a physician who is following his ethical principles to protect patient safety. Physicians should not have to put their careers on the line to protect the health and safety of their patients.”

He said Internal medicine specialists who reverted to prescribing on paper did so after more than a year of advocating for suspension of the IHealth system so it can be fixed to ensure it’s safe for patients. The suspension took place despite other departments in the hospital doing paper-based prescribing.

“The issue at Island Health is a symptom of a bigger problem – a growing tension and mistrust between the health authority administrators and the physicians. We urge the health authority to work constructively and in a meaningful way with physicians whose input is critical to providing the best quality patient care,” he said.

In a written response April 21 to internal medicine going to paper-based orders, Dr. Jeremy Etherington, chief medical officer, said it was inconsistent with Island Health policy and places patients at risk.

“Leaving handwritten order sheets at the desk with the unit clerk or another member of the care team places patients at risk,” he wrote. “There are no staff available who can input handwritten orders into the electronic health record without you, the physician, present.”

In an e-mail to the News Bulletin, Dr. Ben Williams, medical director for Oceanside, said Island Health cannot and will not discuss personnel matters and Island Health expects all members of the medical staff to follow Island Health policies and rules.